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Background: Driveline infections (DLIs) are a common adverse event in patients on ventricular assist devices (VADs) with incidence ranging from 14% to 59%. DLIs have an impact on patients and the healthcare system with efforts to prevent DLIs being essential. Prior to our intervention, our program had no standard driveline management presurgery and postsurgery. The purpose of this Quality Improvement (QI) initiative was to reduce DLIs and related admissions among patients with VAD within the first year post implant., Methods: In anticipation of the QI project, we undertook a review of the programs' current driveline management procedures and completed a survey with patients with VAD to identify current barriers to proper driveline management. Retrospective data were collected for a pre-QI intervention baseline comparison group, which included adult patients implanted with a durable VAD between 1 January 2017 and 31 July 2018. A three-pronged care pathway (CP) was initiated among patients implanted during August 2018 to July 2019. The CP included standardised intraoperative, postoperative and predischarge teaching initiatives and tracking. Using statistical process control methods, DLIs and readmissions in the first year post implant were compared between patients in the CP group and non-CP patients. P-charts were used to detect special cause variation., Results: A higher proportion of CP group patients developed a DLI in the first year after implant (52% vs 32%). None developed a DLI during the index admission, which differed from the non-CP group and met criteria for special cause variation. There was a downward trend in cumulative DLI-related readmissions among CP group patients (55% vs 67%). There was no association between CP compliance and development of DLIs within 1 year post implant., Conclusion: The CP did not lead to a reduction in the incidence of DLIs but there was a decrease in the proportion of patients with DLIs during their index admission and those readmitted for DLIs within 1 year post implant. This suggests that the CP played a role in decreasing the impact of DLIs in this patient population. However, given the short time period of follow-up longer follow-up will be required to look for sustained effects., Competing Interests: Competing interests: HB contributed to Consultant for Abbott. JC contributed to non-restricted education grant from Abbott; Medical Monitor for Pumpkin Trial. DHF contributed to Stock Owner for Tevosol., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Overview: First bite syndrome (FBS) is an orofacial pain condition characterized by moderate to severe unilateral facial pain associated with the first bite or taste of food. It is important that dentists and physicians be aware of patient history and examination findings commonly associated with FBS, as well as treatment options available for managing this condition., Case Description: Described here is a case of FBS arising in a 43-year-old man after partial parotidectomy for the treatment of a mucoepidermoid carcinoma. His orofacial pain was being successfully treated by injection of onabotulinumtoxin A into the residual parotid tissue., Conclusions and Practical Implications: Onabotulinumtoxin A is a promising therapeutic option for FBS owing to its profound relief of pain and minimal reported adverse effects. Therefore, oral health care providers treating FBS should be aware of this option., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)